Paediatric Sports Injuries

Growing bodies are not simply smaller adult bodies. Children and adolescents have open growth plates, rapidly changing bone density, and different injury patterns from adults. A sports injury in a child or teenager needs to be assessed and managed with an understanding of these differences - not simply treated with the adult protocol for the same injury. Goji’s physiotherapists are trained in paediatric and adolescent musculoskeletal presentations and provide evidence-based assessment and rehabilitation for children from primary school age through to age 18.

What makes paediatric sports injuries different?

The key difference is the growth plate (physis). In children and adolescents, the growth plates - cartilaginous zones at the ends and along the shafts of long bones - are the sites of bone lengthening. Growth plate cartilage is mechanically weaker than the surrounding bone and ligament, which means that forces that would cause ligament sprains in adults often cause growth plate injuries (physeal fractures) in children. This changes both the initial management and the return-to-sport timeline.

Additionally, the tendons that attach to growing bone are subject to traction forces during rapid growth phases, leading to a specific group of conditions called apophyseal traction injuries - the most common of which are Osgood-Schlatter disease and Sever’s disease.

Osgood-Schlatter disease

Osgood-Schlatter presents as pain, swelling, and tenderness at the tibial tubercle - the bony bump just below the kneecap where the patellar tendon attaches. It is most common in active adolescents (10-15 years) during growth spurts and is caused by repetitive traction on the developing apophysis by the quadriceps muscle group. Basketball, football, netball, and running are common contexts. It is not a serious condition, but it is painful and requires load management and targeted rehabilitation to keep the young athlete active without prolonged absence from sport.

Sever’s disease

Sever’s disease (calcaneal apophysitis) is pain at the back of the heel, where the Achilles tendon inserts into the calcaneus (heel bone). Like Osgood-Schlatter, it occurs during active growth and is driven by traction through the tight Achilles tendon on the immature heel apophysis. It is the most common cause of heel pain in children aged 8-14 and is frequently bilateral. Management focuses on Achilles flexibility, calf strengthening, load management, and footwear assessment.

What does a session at Goji involve?

Our physiotherapist will take a history of the injury - mechanism, duration, what makes it better or worse, and your child’s sport and training load. The physical assessment varies by presentation but typically includes:

• Palpation and provocation testing of the affected area
• Strength and flexibility assessment: identifying contributing factors such as tight hip flexors, weak glutes, or reduced ankle dorsiflexion
• Biomechanical screen: watching the child run, jump, or perform sport-relevant movements where appropriate
• Growth plate screening: assessing for features that suggest a physeal injury requiring imaging, and referring for X-ray if indicated

Management is graduated and specific to the child’s age, growth stage, and sport. The goal is always to keep the child as active as possible during rehabilitation - not to enforce complete rest unless specifically indicated. Return-to-sport milestones are clear and objective.

Common paediatric sports presentations at Goji

• Osgood-Schlatter disease (knee, tibial tubercle)
• Sever’s disease (heel, calcaneal apophysis)
• Ankle sprains: ligament injuries are common in court sports and on uneven ground
• Patellofemoral pain syndrome: anterior knee pain with running, stairs, and prolonged sitting
• Stress reactions and stress fractures: particularly in high-mileage runners and dancers
• Shoulder injuries: particularly in swimming and overhead sports
• Hamstring and groin strains

Frequently asked questions

My 12-year-old has knee pain after football training. When should we see a physio vs a doctor?

For activity-related pain that eases with rest and has no swelling or locking, a physiotherapy assessment is appropriate first. If there is significant swelling, inability to bear weight, pain at night, or if the pain came from a specific traumatic incident (a fall, a twist), see a GP, orthopaedic specialist, or go to A&E first for imaging to rule out fracture or significant structural injury.

How long do kids with Osgood-Schlatter or Sever’s need to stop sport?

Complete rest is not usually necessary or advisable. The goal is load management - reducing the volume and intensity of provocative activities to a level that allows participation without aggravating pain, while building the capacity to increase load progressively. Full sport participation is typically possible throughout management with appropriate modifications, and both conditions resolve naturally when growth is complete.

My daughter is a competitive runner and has been told she has a stress fracture. What is the rehab like?

Stress fractures in adolescent athletes - particularly in the tibia, fibula, and metatarsals - require a period of protected weight-bearing and reduced impact, the duration of which depends on location and severity. Physiotherapy then manages the return to running progressively, addressing the training load, footwear, biomechanics, and nutritional factors (particularly the female athlete triad, where low energy availability is an important contributor). Goji will coordinate with the treating physician on the return-to-running protocol.

Is my child too young to strength train?

No. Resistance training is safe and beneficial for children from primary school age when supervised appropriately. Evidence consistently supports strength training for young athletes in terms of injury prevention, performance, and bone health. Our physiotherapist will design age-appropriate and sport-relevant programmes that are safe for children with open growth plates.

My child plays three sports and trains every day. Could overtraining be part of the problem?

Yes, very likely. Overuse injuries in young athletes - including both apophyseal conditions and stress fractures - are strongly associated with high training volume, insufficient recovery, early specialisation in a single sport, and inadequate nutrition. Our physiotherapist will assess the training load and, where overtraining is a contributing factor, advise on appropriate restructuring alongside rehabilitation.

My child had their injury over a year ago and was never properly rehabilitated. Is it too late?

No. Late rehabilitation of a sports injury is still valuable, particularly for addressing the underlying contributing factors - muscle imbalances, mobility restrictions, biomechanical habits - that a standard rest-and-wait approach doesn’t address. Our physiotherapist will assess the current state of the injury and any ongoing compensatory patterns.